ACTHA: Join Association

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Registration Information

Membership Type:

Friend's Member ID:
***NOTE: If you have been referred by a current member of ACTHA enter their member ID in the box above

Email:
Verify Email:

Billing Information

First Name:
Last Name:
ENSURE THE ADDRESS USED MATCHES THE CREDIT CARD THAT IS INPUT BELOW
Address:	Street
	City State Zip

Phone Number:	(ie 8774222842)

How did you hear about ACTHA:

Gift Certificate Number:	(If applicable)
If you use a Gift Certificate, a Credit Card Number is still required for all future purchases and to verify age.

Credit Card Number:
Exp Date (MM/YY):	/ CIV:
Terms: I agree to have my credit card listed above charged for the ACTHA membership I have selected. I also understand that my annual membership will be automatically billed to this credit card annually unless I notify ACTHA BEFORE the next renewal date.